Memo to Duncan Smith: unlike the UK, the US has recovered from recession

The Work and Pensions Secretary is wrong to criticise the performance of the US economy.

It took some chutzpah for Mitt Romney supporter Iain Duncan Smith to declare on BBC Radio 5 Live last night that it was "very worrying" that the United States hadn't "bounced back from this recession". Unlike the UK, the US has more than recovered from the downturn of 2008-09.

As the graph below shows, while the US has grown consistently since leaving recession in the third quarter of 2009 (with the exception of Q1 2011 when output was flat), Britain has only recently returned to growth after three quarters of contraction. Indeed, by one definition at least, we're still in recession. Unlike the US economy, which is now 2.3 per cent above its pre-recession peak, the UK economy is still 3.1 per cent smaller than it was in the first quarter of 2008. Over the last year, while UK output has remained flat, the US has grown by 2.3 per cent.

The divergence in performance is due in no small part to the decision of the US government to pursue stimulus and the decision of the UK to pursue austerity. Barack Obama's $787bn fiscal stimulus, a mixture of tax cuts, infrastructure projects and increased unemployment benefits, is estimated to have increased real US GDP by around 3.4 per cent and to have created or saved 2.7 million jobs (see this study by Mark Zandi, a former economic adviser to John McCain, and Alan Blinder, a former vice-chairman of the Federal Reserve). By contrast, the coalition's (non-expansionary) fiscal contraction is thought to have reduced GDP by 4.3 per cent this year.

Duncan Smith is welcome to invite comparison of the two economies (not least because it aids the case against the government's policies), but he should know that there can only be one winner.

Barack Obama speaks during a campaign rally in Cincinnati, Ohio. Photograph: Getty Images.

George Eaton is political editor of the New Statesman.

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Testing migrant children’s teeth for their age is not only immoral – it doesn’t work

Ministers have flirted with this idea for over a decade. It’s bad policy, as well as poor ethics.

This week, the Home Office finally ruled out the use of x-rays to establish the age of childhood migrants.

It’s welcome news, but this story predates the dispersal of the Calais “Jungle” camp. 

For over ten years, ministers in Conservative and Labour governments have flirted with these tests. And it’s been up to us – the practitioners who’d be expected to administer them – to pick holes in a policy that’s a great way of securing headlines, but simply cannot deliver on the claims made by its cheerleaders.

It goes without saying dentists are health professionals, not border guards. But our objections run deeper than that. And it’s worth revisiting the arguments, just in case future governments start grasping for silver bullets.

It’s ineffective

We can talk about philosophy later, but let’s start with a pretty fundamental objection: dental x-rays are simply not a reliable way of establishing age.

No two mouths are alike. I’ll add my own to that list, as I still sport two of my baby teeth.

Children and young people mature at different rates, so the level of accuracy in these tests changes with time. And these x-rays can estimate age in younger children much more accurately than in adolescents. So as children mature at different rates, the potential margin of error gets ever larger with age.

For example, the third molars, commonly known as wisdom teeth – the last permanent teeth to develop – can form any time between the ages of 16 and 23, and a small proportion of individuals never develop third molars at all (I’ll have to pop my name to that list too).

A 2010 study of 300 young people aged between 11 and 25, whose age was determined based on dental x-rays, showed this method of testing consistently over- or under-estimated age, with a two-year average difference between dental and known age.

So if you are searching for a litmus test that will tell you whether a subject is 17 or 19 years old you won’t find it here.

It’s inappropriate

A few MPs and pundits have found it hard to acknowledge the codes health practitioners sign up to, which make this test a no go.

We must always act in the best interest of our patients when providing a medical procedure. And it is beyond question that the process of radiography is a medical procedure that should be carried out only for medical purposes, and where the patient stands to benefit.

Now many people might not consider this test an invasive procedure. However, x-rays do carry a small risk of possible long-term physical impact, and current best practice in this area dictates that exposure to radiation should be kept as low as reasonably possible over a lifetime. They should be carried out sparingly and where there is a well-defined potential clinical benefit, which must always outweigh the potential clinical harm.

As taking x-rays to determine the age of an individual carries no clinical benefit, it frankly isn’t appropriate to expose a patient to the potential clinical harm it can cause.

It’s unethical

Our lawmakers cannot simply dispense with fundamentals like consent to show they are “taking action”.

It is a legal principle that before practitioners carry out any medical procedure, the recipient – or someone who can consent on their behalf – must be given a full understanding of the nature of the procedure, its significance, impact and potential consequences before signing up to it.

For the children arriving from Calais, this would be a difficult task without English as a first language. Consent may also be required from a suitable adult. Yes, these children may be unaccompanied, but it does not mean the need for valid consent and protecting the child’s best interests can simply be ignored.

The letter of the law might be inconvenient, but it is a requirement that can only be compromised where the urgency and necessity of the circumstances demand rapid action in a patient’s best interests. And even in these circumstances the validity of treatment has sometimes ended up being challenged in the courts.

Given that taking x-rays in order to determine age is not medically justifiable in the first place, the urgency justification really doesn’t come into play. And that means dental colleagues – in the absence of valid consent – could find themselves performing an act that constitutes a criminal battery.


In the past, ministers have debated whether there is a credible “public interest” case that might override these little legal or philosophical objections. But these practical and ethical concerns can’t really be separated.

But why bother constructing a case for a test that frankly isn’t much cop? Dentists can only hope the latest message from the Home Office marks the beginning of a consensus, which draws a line under a decade of wishful thinking.

Judith Husband, Chair of the British Dental Association’s Education, Ethics and the Dental Team Working Group.